Long-term followup and deterioration rate of anterior substitution urethroplasty

Guido Barbagli, Sanjay B. Kulkarni, Nicola Fossati, Alessandro Larcher, Salvatore Sansalone, Giorgio Guazzoni, Giuseppe Romano, Joshi M. Pankaj, Vincenzo Dell'Acqua, Massimo Lazzeri

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose We investigated deterioration of the success rate of penile and bulbar substitution urethroplasty. Materials and Methods We performed a retrospective descriptive analysis of patients who underwent substitution urethroplasty between July 1994 and September 2007. Inclusion criteria included 1-stage anterior urethroplasty using penile skin or oral mucosa with a minimum of 6 years followup. Patients with posterior urethral stricture, failed hypospadias or incomplete clinical records were excluded from analysis. The primary study outcome was postoperative failure-free survival and the secondary outcome was to identify significant predictors of treatment failure. The clinical outcome was considered a failure when any postoperative instrumentation was needed. Descriptive statistical analysis was done as well as Kaplan-Meier analysis, and univariable and multivariable Cox regression analysis. Results A total of 359 patients were included in study. Median followup was 118 months. Of the procedures 265 (73.8%) were successful and 94 (26.2%) failed, including 91 (96.8%) within the first 5 years. Substitute tissue type (oral mucosa vs skin) was the only significant predictor on univariable analysis (HR 1.86, p = 0.005). This result was confirmed by multivariable analysis adjusting for age at surgery, stricture length and etiology, urethroplasty type and previous treatments (HR 2.26, p = 0.001). Conclusions Deterioration after anterior 1-stage substitution urethroplasty seems to develop within the first 5 years. Oral mucosa showed greater failure-free survival than penile skin and 1-stage penile urethroplasty showed the same success rate as bulbar urethroplasty.

Original languageEnglish
Pages (from-to)808-813
Number of pages6
JournalJournal of Urology
Volume192
Issue number3
DOIs
Publication statusPublished - 2014

Keywords

  • patient outcome assessment
  • reconstructive surgical procedures
  • transplants
  • treatment failure
  • urethra

ASJC Scopus subject areas

  • Urology

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